Hypertensive Disorders in Pregnancy (HDP) represented 15.4% of total numbers of maternal death- the 4th main cause after obstetric embolism, PPH and other medical non HDP conditions
The risk for intracerebral hemorrhage (ICH) in pregnant women was the highest during the 3rd trimester and early postpartum. Intracerebral hemorrhage (ICH) accounts for a substantial portion of pregnancy-related mortality. The risk of ICH associated with pregnancy is greatest in the postpartum period. Advanced maternal age, African American race, hypertensive diseases, coagulopathy, and tobacco abuse were all independent risk factors for pregnancy-related ICH
Hypertensive Disorders in Pregnancy (HDP) represented 15.4% of total numbers of maternal death- the 4th main cause after obstetric embolism, PPH and other medical non HDP conditions
The risk for intracerebral hemorrhage (ICH) in pregnant women was the highest during the 3rd trimester and early postpartum. Intracerebral hemorrhage (ICH) accounts for a substantial portion of pregnancy-related mortality. The risk of ICH associated with pregnancy is greatest in the postpartum period. Advanced maternal age, African American race, hypertensive diseases, coagulopathy, and tobacco abuse were all independent risk factors for pregnancy-related ICH
gestational trophoblastic disease is discussed in its basic knowledge update to enable undergraduate students help understand the disease, diagnose and treat GTD. also enables to follow and detect complications and malignant transformation of molar pregnancy. single drug and multiple dose chemotherapy depending on staging of the disease and related complications & side effects discussed.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. 1. EVALUATE PATIENT
2. EVACUATE THE MOLE
3. MANAGEMENT Of THECA LEUTIN CYST
4. ROLE OF HYSTERECTOMY
5. FOLLOW UP
6. NATURAL HISTORY OF MOLAR
PREGNANCY
7. ROLE OF PROPHYLACTIC CHEMOTHERAPY
8. MANAGEMENT OF PREGNANCY AFTER
MOLE
3. ◦ associated medical complications
including preeclampsia
hyperthyroidism,
electrolyte imbalance
anemia.
◦ After the patient’s condition is stabilized-
Suction evacuation-(S/E), irrespective of period
of pregnancy.
Management of GTD-Mole
1. Evaluate patient-
5. Oxytocin infusion—started after cervical dilatation
Cervical dilation—As the cervix is being dilated, uterine
bleeding often increases (Retained blood in the endometrial cavity may be expelled during
cervical dilation) Active uterine bleeding should not deter the
prompt completion of cervical dilation.
Suction curettage—Within a few minutes of suction
curettage, uterine size may decrease & bleeding will be
controlled.
uterus - >14weeks of gestation, one hand should be
placed on top of the fundus, & massaged to stimulate
uterine contraction and reduce the risk of perforation.
6. Sharp curettage—When suction evacuation is completed, gentle sharp
sharp curettage is performed to remove any residual molar tissue.
◦ Rh–VE – GIVE ANTI-D
Because trophoblast cells express RhD factor, patients who are Rh negative should
receive Rh immune globulin at the time of evacuation
Informed consent
Hydration
Wide bore I.V canula
Blood should be cross matched
Stabilize pt- (htn, hyperthyroid, anemia)
Passage of uterine sound- avoided
Usually cervical dilatation not required
12 mm canula, tip should be just above int
os
Cannula not to be advance till fundus
Intraoperative usg guidenence may be
useful
7. 3.MANAGEMENT Of THECA LEUTIN
CYST
◦ Usually resolved spontaneously
◦ Pressure symptoms +
USG guided cyst aspiration may be done
◦ Torsion-
laparotomy and ovariotomy ( older days)
laproscopic manipulation treatment of choice
8. 4.HYSTERECTOMY
◦ If the patient desires surgical sterilization (age
>40yrs), a hysterectomy may be performed with the
mole in situ.
◦ The ovaries preserved- even in the presence of
prominent theca lutein cysts.
◦ Large ovarian cysts may be decompressed by
aspiration. Hysterectomy does not prevent
metastasis; patients still require follow-up with
assessment of hCG levels
9. 5. FOLLOW UP
◦ No marker to decide which molar pregnancy will proceed
to choriocarcinoma.
◦ Histological features no clue to the future behaviour of the
mole and its progression to carcinoma
◦ decision in the follow-up should not be influenced by
histology
◦ Follow-up for 2 years remains the only option for detecting
early choriocarcinoma (if it occurs, develops within this period of evacuation
of the mole)
10. ◦ A method of detecting persistent moles and development of
choriocarcinoma – estimation of the hCG level in the serum
and urine.
Human Chorionic Gonadotropin
◦ After evacuation, patients should be monitored with hCG
levels ( an hCG assay that can detect all forms of hCG including beta-hCG, core hCG, C-terminal hCG, nicked-free beta,
beta core, and preferably the hyperglycosylated forms, should be used. ) until these levels are
normal for 3 consecutive weeks, followed by monthly until the
levels are normal for 6 consecutive months.
◦ usually first normal hCG level after evacuation is about 8
weeks
◦ nondetectable serum hCG levels- risk of relapse is low
11. Post molar surveillance-by βhCG
levels
serum βhCG - within 48hrs after evacuation.
Serum βhCG once in 1 week, till 3 consecutive -ves (<5
mIU/L)
If βhCG becomes normal ≤8Wks after evacuation,
βhCG once in a month for 6 months from the time of evacuation
one month for partial mole.
If βhCG doesn’t become negative>8wks,
weekly βhCG until negative followed by monthly once until 6 months
from the time of first negative, then allowed pregnancy.
12. ◦ At Charing Cross Hospital, the hormone is measured in serum
and urine then in urine only for several months once values are
normal. If patients follow this protocol, the risk of missing
treatable disease is about 1:2000
◦ Other centres in the world have advocated using shorter follow-
up protocols, particularly for partial mole, where the risk of
malignancy is lower.
◦ This increases the risk of undetected malignant disease- do not
advocate shortening follow-up.
13.
14. ◦ Pelvic examination -any vulval and vaginal metastasis, and the
uterine size is recorded.
◦ ovarian cyst -reduction in size noted
◦ CXR – to detect lung metastasis.
◦ Persistent uterine bleeding calls for a curettage-sent for HPE
{detect choriocarcinoma}
◦ Pelvic ultrasound scan can detect residual or locally invasive
tumour as well as an ovarian cyst.
◦ Pregnancy should be avoided preferably by barrier methods
for at least 1 year (preferably 2 years) as a fresh pregnancy
would interfere with the hCG levels .
Follow up cont.
15. ◦ Complete mole -15-20% to develop GTN
◦ Partial mole -0.1-5%
◦ Patient education –is crucial to understand and
comply with surveillance protocols
Why follow up is very imp?
(Post molar surveillance)
16. FOLLOW UP (contraception)
◦ During entire period of follow up - reliable
contraception
◦ Barrier methods- until Monthly βhCG reverts to
normal
◦ IUCD -after βhCG –ve (Because of the potential risk of uterine perforation, bleeding, and infection, IUCD
should not be inserted until the patient achieves a normal hCG level.)
◦ oral combined contraceptives pills may be used safely
after molar evacuation during the entire interval of
hormonal follow-up.(Oral combined pills lower the luteinizing hormone (LH) level
and thereby, the hCG level and can cause misinterpretation of results. )
◦ progestogen-only pills cause irregular bleeding
17. 6.NATURAL HISTORY OF MOLAR
PREGNANCY
• Resolution occurs in 80% of complete moles and 96% of
partial moles
• Molar pregnancies @high risk for development of persistent
GTN
- hcg > 1lakh mlIU/ml
-fundal height greater than POG
-bilateral thecal cysts
- respiratory distress after evacuation , eclampsia,
hyperthyroidism
- subinvolution of uterus, irregular bleeding p/v after
evacuation
18. 7.Prophylactic Chemotherapy
◦ Prophylactic chemotherapy -controversial.
◦ As exposing all patients to potentially toxic treatment
when only about 20% are at risk of developing
persistent tumor.
◦ Prophylaxis may be particularly useful -high-risk
complete molar pregnancy, especially when hCG
assessments for follow-up are unavailable or
unreliable.
19. 8.Management of pregnancy after mole
◦ Avoid conception -6 months after hCG normalize (molar
pregnancy)
◦ Persistent GTD- post chemotherapy -12 months in low risk
and 24 months in high risk
◦ Risk of subsequent molar pregnancy
>one molar --- 1-1.9%
>two molar --- 15-19%
◦ Next pregnancy -1st trimester USG
◦ H/P/E of Placenta or products- after each pregnancy
◦ β- hCG 6& 10 weeks after each subsequent pregnancy
20. Algorithm for diagnosis & management
of Hydatidform mole
(Complete or partial)
Physical and pelvic examination, Pelvic ultrasound
-Blood count, transfusion if needed
-Blood investigations(renal, hepatic, thyroid)
Baseline serum βhcg, Chest X-ray
Evacuation by suction
(Hysterectomy only if needed)
Monitor serum βhCG once in 1 week
EFFECTIVE contraception & follow up
21. Recurrence
◦ Consecutive mole cases tested for germline
mutations
◦ Mutations in germlines- NLRP7 ,KHDC3L
,PADI6 genes
◦ Mutant cases- assisted reproductive technique
with use of donor eggs recommended foe
future pregnancy
22. Criteria for Diagnosis of GTN (FIGO)
◦ β hCG –plateau across 4 measurements over a three week period
(days1,7,14,21) ( with in≤10% rise of the previous result)
◦ β hCG –rise >10% in 3 measurements over a two week
period (days1,7,14)
◦ βhCG remain elevated for >6 months
◦ Histological diagnosis of Chorio carcinoma
23. Staging of Gestational Trophoblastic Neoplasia
Stage I Disease confined to uterus
Stage II GTN extending outside uterus but limited to
genital structures (adnexa, vagina, broad
ligament)
Stage III GTN extending to lungs with or without
genital tract involvement
Stage IV All other metastatic sites
24. FIGO/WHO Risk Scoring System
0 1 2 4
Age (years) <40 >40
Antecedent pregnancy Mole Abortion Term
Interval between
pregnancy and start of
chemotherapy (months)
≤4 4 - 6 7 - 12 ≥12
Pre-treatment hCG
(mIU/mL)
≤ 103 103 - 104 104 - 105 ≥ 105
Largest tumour,
including uterine (cm)
- 3 -4 ≥ 5 -
Site of metastases
including uterus
lung Spleen,
kidney
Gastrointestinal
tract,
Brain
liver
Number of metastases 1 - 4 5 - 8 >8
Prior -failed
chemotherapy
--- --- single
drug
2or >
drugs
Total score: ≤ 6-low risk ≥7-high risk >12 Ultra high risk
25. REFERENCES
◦ International Society for the Study of Trophoblastic Disease, European
Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic
Cancer InterGroup. Mangili G, Lorusso D, Brown J, Pfisterer J, Massuger L, Vaughan
M, Ngan HY, Golfier F, Sekharan PK, Charry RC, Poveda A, Kim JW, Xiang Y,
Berkowtiz R, Seckl MJ.Int J Gynecol Cancer. 2014 Nov;24(9 Suppl 3):S109-16. doi:
10.1097/IGC.0000000000000294. Review.PMID: 25341573
◦ Berek and novaks gynecology 16th edition
◦ Essentials of obstetrics – Poonam Sachdeva
◦ Shaw-16th edition
◦ https://www.bmj.com/bmj/section-
pdf/186556?path=/bmj/337/7667/Clinical_Review.full.pdf
The total score for a patient is obtained by adding the individual scores for each prognostic factor, Total score:Less than 7-low risk, More than or equal to 8-high risk.